I posted a post like this back in March of this year, gosh, reading and typing that I cannot believe it's almost the end of September and I am still having trouble with my weight! Here goes my post: 

Hi there everyone! My name is Christy. I just turned 34. I am 5'2 ( I swear I think I have shrunk an inch this past year) and 193lbs. roughly, now I am about 200lbs).

I am very interested in getting some type of weight loss surgery. I say some type because, I know I am not eligible for the roux-en-Y or regular gastric bypass surgery with the re-routing of intestine surgery, because I had colon cancer at 28, and I have no large intestine, they performed a procedure called a total colectomy on me, so basically my small intestine is connected to about 2 inches of my rectum.

Long story short, initially when I posted on here I had BCBS and they specifically stated theeir requirements etc., Now I have UHC POS and they cover it 100% with a covered provider and facility but they don't stipulate any other information, for example, when my providers at Dr. Denis Halmi's office in Woodbridge VA contacted them at the beginning of Sept-when my now UHC POS became effective they replied back to them and told the provide they want something that displays a 5 year history. I called UHC and they didn't tell me much either.  Having had cancer I have seen numberous docs in the last five years. My game plan is to go to those docs like my onocologist, pain management, neurosurgeons, fertility doc, etc., and ask them to write a letter on my account stating they advise the procedure to be done for overall health improvement.

I have always had issues with food addiction, I am the largest person in my immediate family, and have always been. I was always told I was "big boned" but personally, I've never seen a fat skeleton!

I am interested in having the sleeve gastrectomy done, and I've been to three separate doctors that suggest that as well, stating I could have complications with a lap band and end up with a colostomy bag and I would starve to death with the way the normal procedure is carried out. The docs all agree o the sleeve, with 80% stomach removal. This I feel for me would be a double benefit-my colon cancer gene prediposes me to an increase in stomach cancer by about 13%-which isn't a lot but every bit helps! :)

I have the following other medical issues that will accomodate my reasoning for my surgery:
-high blood pressure-2.5-3 years
-GERD-10
-infertility-5
-sleep apnea-I don't use a CPAP though-1 I have upper airway restructive syndrome
-Disc disease-along with 3 slipped discs, an impinged nerve and annualar tear in my lumbar spine.
-I've already had my gallbladder removed-but I had issues with this
the increased weight bothers my knees and my carpal tunnel as well.
-Depression
-Fibromyalgia

I have now found my surgeon, Dr. Denis Halmi, we have discussesd that the gastric sleeve would be the best option for me and my current situation, however, given that my inusrance company-UHC POS-is new to me, they want a 5 year history on me which pertains mainly to my weight IMO. 2 years ago I was this weight, but not 5, I've fluctuated from 200 down to 150 up to 165, 175, stayed back up to 180 then to 200. I am wondering at this point if it would be worth me trying to see if this wil get approved after all, has anyone else experienced this? 

 Yeah having the pre stuff done means they are involved for paying for that portion but they get no say in whether you have the surgery or not, that is up to Dr. Lin and his team.  It's one of the reasons I fought so hard to get my husband to stay in this region.  I'm only just voer BMI of 40 with no co-morbidities so I knew if I was going through tricare it would be risky.

The way it works is if you are being treated through an MTF for anything really it never sees Tricare.  But as soon as it isn't MTF then it goes through Tricare.  Its sorta nice for Dr. Lin because they get to set up their rules (like you only have to see the dietician 3x) and any weight loss after initial acceptance doesn't count against you.  I found out through tricare that if I saw the dietician for 6 months and then fell below the 40, I'd be denied!!!  I mean what sense does that make.  

I just started all my pre-op stuff but I already have all my appointments booked (except the last 2 dietician ones), my first WLS support group meeting is on Tuesday in Waldorf.  I'm hoping to be able to get through this stuff and get my surgery for January, Feb at the latest as we are PCSing AGAIN (we just moved here May 1) in May.

 Just so you know if you're going to an MTF it didn't go through Tricare. . .  Basically being seen at an MTF means you follow their rules not tricares.  But great job being approved through the MTF.  I am to at Bethesda.

Well Folks, I have a date of 10/3/11 to get sleeved, unfortunately I have been denied not once but twice already..the first being from the original submission the 2nd my surgeon and a MVP medical doctor case conferenced and it was still denied..soo now I have to appeal!  and I need any advice on this that is available!!! ....My doctors ofice is telling me to keep all my pre-op appointments etc but I dont really want to waste all that money paying for co-pays if Im not gonna be able to have my surgery, very frustrating...another thing is m doctors office is telling me to chose another surgery, personally Its not that easy for me, I have my mind set and have researched on a particular procedure so for me to be told to do the rny or the band..umm no!..lol..sorry to vent! but please help!! 

Tricare actually has new rules now. It isnt on the tricare websites, but it is in the tricare policy manual as of 8/17. The policy is supposed to be on the tricare sites in a week or so from now but it is actually on the Tricare Management Activity website under the tricare policy manual. It is based on the 35-39 bmi w comorbidities and 40 and over without any comorbidities needed.

http://manuals.tricare.osd.mil/DisplayManualPdfFile/TP02/145/AsOf/TP02/C4S13_2.PDF


I believe this is the page that can give you the new information.